POS0443 EXPLORING NOVEL TENOSYNOVITIS AND COMBINED INFLAMMATION IMAGING OUTCOMES: RESULTS FROM A RANDOMISED CONTROLLED TRIAL IN EARLY RHEUMATOID ARTHRITIS

Background:

Magnetic resonance imaging (MRI) trial outcomes have largely focused on synovitis, bone marrow oedema (BME) and erosions. Tenosynovitis is a common manifestation of rheumatoid arthritis (RA), but is relatively understudied; a combined inflammation score (CIS) summing synovitis, BME and tenosynovitis may be a highly responsive measure. We previously showed the responsiveness of the Outcome Measures in Rheumatology (OMERACT) RA MRI scoring system (RAMRIS) and a machine-learning derived automated tool (RAMRIQ) in a randomised controlled trial (RCT) of tofacitinib and methotrexate (MTX) in MTX-naïve patients (pts) with early RA.1

Objectives:

This post hoc analysis assessed the impact of tofacitinib ± MTX on MRI tenosynovitis and CIS in pts with early RA using semiquantitative and quantitative MRI outcomes.

Methods:

Study A3921068 (NCT01164579), a 1-year, exploratory, Phase 2, RCT, compared tofacitinib 10 mg twice daily (BID) ± MTX, and MTX monotherapy, in MTX-naïve pts with early RA.1 MRI of unilateral wrist and metacarpophalangeal joints was performed at screening/baseline (BL) and Months (M)1/3/6/12. MRI tenosynovitis and CIS were assessed using RAMRIS and RAMRIQ. Changes from BL (Δ) in RAMRIS and RAMRIQ tenosynovitis and CIS were evaluated at M1/3/6/12. Data were assessed using a mixed-effect model for repeated measures, with treatment arms as factors and BL values as covariates. Using data pooled across treatment arms, Spearman’s rank correlation coefficients were calculated for associations between BL RAMRIS and BL RAMRIQ tenosynovitis and CIS vs BL Disease Activity Score in 28 joints, C-reactive protein (DAS28-4[CRP]), and ΔRAMRIS and ΔRAMRIQ tenosynovitis and CIS at M12 vs ΔDAS28-4(CRP) at M12.

Results:

In total, 109 pts were randomised and treated. ΔRAMRIS and ΔRAMRIQ tenosynovitis and CIS were generally significantly greater at M3/6/12 in pts receiving tofacitinib ± MTX vs MTX, while ΔRAMRIQ CIS was also significantly greater at M1 (Figure 1). Compared with RAMRIS, RAMRIQ outcomes were generally more responsive to treatment with tofacitinib ± MTX. Significant correlations were seen between BL RAMRIS and BL RAMRIQ tenosynovitis and BL RAMRIS CIS vs BL DAS28-4(CRP), and between ΔRAMRIS and ΔRAMRIQ tenosynovitis and CIS at M12 vs ΔDAS28-4(CRP) at M12 (Table 1). In general, stronger correlations were seen between BL DAS28-4(CRP) and BL RAMRIS vs BL RAMRIQ parameters, while correlations were similar between ΔDAS28-4(CRP) at M12 and ΔRAMRIS and ΔRAMRIQ parameters at M12.

Table 1.

Correlations between a) BL RAMRIS and BL RAMRIQ tenosynovitis and CIS vs BL DAS28-4(CRP) (N=109) and b) ΔRAMRIS and ΔRAMRIQ tenosynovitis and CIS at M12 vs ΔDAS28-4(CRP) at M12 (N=73) across treatment armsa

a)BL DAS28-4(CRP)b)ΔDAS28-4(CRP)BL imaging featureCorrelationp valueΔImaging featureCorrelationp valueRAMRIStenosynovitis0.3660.0001RAMRIStenosynovitis0.531<0.0001RAMRIS CIS0.399<0.0001RAMRIS CIS0.554<0.0001RAMRIQtenosynovitis0.2050.037RAMRIQtenosynovitis0.543<0.0001RAMRIQ CIS0.1800.062RAMRIQ CIS0.564<0.0001

aData were pooled across the tofacitinib 10 mg BID ± MTX and MTX monotherapy arms

Spearman’s rank correlation coefficients and p values were calculated for associations between RAMRIS and RAMRIQ parameters and DAS28-4(CRP); tenosynovitis and CIS were assessed using combined data from metacarpophalangeal and wrist joints; CIS is the sum of synovitis, BME and tenosynovitis values

Δ, change from BL; N, number of pts with values at BL/timepoint of interest

Conclusion:

Responsiveness of RAMRIS and RAMRIQ tenosynovitis and CIS was demonstrated with significant improvements through M12 in pts receiving tofacitinib 10 mg BID ± MTX vs MTX. Construct validity for RAMRIS and RAMRIQ tenosynovitis and CIS was evident from correlations with DAS28-4(CRP). Further work is needed to validate these novel imaging biomarkers in terms of relative responsiveness and prediction of later structural progression.

References:

[1]Conaghan et al. Ann Rheum Dis 2016; 75: 1024-1033.

Acknowledgements:

Study sponsored by Pfizer Inc. Medical writing support was provided by Jennifer Arnold, CMC Connect, and funded by Pfizer Inc.

Disclosure of Interests:

Philip G Conaghan Speakers bureau: AbbVie, Novartis, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, Flexion, Galapagos, Gilead Sciences, GlaxoSmithKline, Janssen, Novartis, Pfizer Inc, Regeneron, Mikkel Østergaard Speakers bureau: AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Centocor, Eli Lilly, GlaxoSmithKline, Hospira, Janssen, Merck, Mundipharma, Novartis, Novo, Orion, Pfizer Inc, Regeneron, Roche, Schering-Plough, Takeda, UCB, Wyeth, Consultant of: AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Centocor, Eli Lilly, GlaxoSmithKline, Hospira, Janssen, Merck, Mundipharma, Novartis, Novo, Orion, Pfizer Inc, Regeneron, Roche, Schering-Plough, Takeda, UCB, Wyeth, Grant/research support from: AbbVie, Centocor, Merck, Orrin Troum Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Horizon, Novartis, Pfizer Inc, Sanofi-Genzyme, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, Horizon, Pfizer Inc, Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Centocor, Corrona, Novartis, Pfizer Inc, Zhiyong Xie Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Alan Brett Shareholder of: Stryker Corp, Employee of: Stryker Corp, Mark Snyder Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Abbas Ebrahim Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Douglass Chapman Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Gosford Sawyerr Consultant of: Pfizer Inc, Employee of: Syneos Health, John Andrews Shareholder of: Pfizer Inc, Employee of: Pfizer Inc

Association of clinical factors and recent anticancer therapy with COVID-19 severity among patients with cancer: a report from the COVID-19 and Cancer Consortium

BACKGROUND

Patients with cancer may be at high risk of adverse outcomes from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We analyzed a cohort of patients with cancer and coronavirus 2019 (COVID-19) reported to the COVID-19 and Cancer Consortium (CCC19) to identify prognostic clinical factors, including laboratory measurements and anticancer therapies.

PATIENTS AND METHODS

Patients with active or historical cancer and a laboratory-confirmed SARS-CoV-2 diagnosis recorded between 17 March and 18 November 2020 were included. The primary outcome was COVID-19 severity measured on an ordinal scale (uncomplicated, hospitalized, admitted to intensive care unit, mechanically ventilated, died within 30 days). Multivariable regression models included demographics, cancer status, anticancer therapy and timing, COVID-19-directed therapies, and laboratory measurements (among hospitalized patients).

RESULTS

A total of 4966 patients were included (median age 66 years, 51% female, 50% non-Hispanic white); 2872 (58%) were hospitalized and 695 (14%) died; 61% had cancer that was present, diagnosed, or treated within the year prior to COVID-19 diagnosis. Older age, male sex, obesity, cardiovascular and pulmonary comorbidities, renal disease, diabetes mellitus, non-Hispanic black race, Hispanic ethnicity, worse Eastern Cooperative Oncology Group performance status, recent cytotoxic chemotherapy, and hematologic malignancy were associated with higher COVID-19 severity. Among hospitalized patients, low or high absolute lymphocyte count; high absolute neutrophil count; low platelet count; abnormal creatinine; troponin; lactate dehydrogenase; and C-reactive protein were associated with higher COVID-19 severity. Patients diagnosed early in the COVID-19 pandemic (January-April 2020) had worse outcomes than those diagnosed later. Specific anticancer therapies (e.g. R-CHOP, platinum combined with etoposide, and DNA methyltransferase inhibitors) were associated with high 30-day all-cause mortality.

CONCLUSIONS

Clinical factors (e.g. older age, hematological malignancy, recent chemotherapy) and laboratory measurements were associated with poor outcomes among patients with cancer and COVID-19. Although further studies are needed, caution may be required in utilizing particular anticancer therapies.

CLINICAL TRIAL IDENTIFIER

NCT04354701.

POS0775 APLS-ASSOCIATED RETINAL VASCULOPATHY AS A PRESENTATION OF THROMBOTIC MICROANGIOPATHY

Background:

Persistent antiphospholipid antibodies (aPL) positivity was a recognized risk factor for thrombotic events, obstetric morbidity and a variety of manifestations beyond thrombosis. The presence of some non-criteria manifestations including thrombocytopenia, hemolytic anemia, and APS nephropathy should prompt consideration for thrombotic microangiopathy (TMA).1 Patients with APS can also present with a variety of ocular and neuro-ophthalmic manifestations, such as retinal artery/vein occlusion, retinal arteritis, optic neuritis and ischemic optic neuropathy, with underlying mechanisms remained elusive. Retinal vasculopathy including retinal artery occlusion (RAO) or retinal vein occlusion (RVO) was recently found occurred more frequently in APS patients with thrombocytopenia2, suggested other possible mechanisms besides thromboembolism.

Objectives:

To explore risk factors and possible mechanisms of retinal vasculopathy among APS patients.

Methods:

In this single-center case-control study among APS patients, we evaluated patients who fulfilled 2006 Sapporo APS Classification Criteria3 with or without retinal vasculopathy during 2018-2020 at Peking Union Medical College Hospital. Demographic data, aPL-related manifestations, cardiovascular risk factors and antibodies profile were compared and a logistical regression model was built. Hierarchical cluster analysis with the Euclidean distance and the Ward method was applied to identify clusters of variables.

Results:

A total of 310 APS patients (67.4% female, mean age 38.1 years) were included, of whom 18 patients were diagnosed with retinal vasculopathy (9 with RVO and 9 with RAO). No significant differences was found among most demographic characteristics, clinical manifestations, or antibody profile. However, APS-related heart valve disease (OR 13.66, 95% confidence interval [CI] 4.55-40.98), APS nephropathy (OR 12.77, 95% CI 4.04-40.35), thrombocytopenia (OR 2.63, 95% CI 1.01-6.89) and high serum IgM (OR 3.67, 95% CI 1.30-10.40) were predictive of retinal vasculopathy (Figure 1 A). APS-related heart valve disease and nephropathy were also found statistical significant in multivariate logistical regression (Figure 1 B). They and other non-criteria manfestations were aggregated with retinal vasculopathy from cluster analysis of variables (Figure 1 C).

Conclusion:

Patients with APS-related heart valve disease and nephropathy suffered a higher risk of retinal vasculopathy including RAO and RVO. The underlying mechanisms of aPLs-associated retinal vasculopathy may involve TMA, leading to a poor prognosis and therapeutic changes.

References:

[1]Kotzen ES, Roy S, Jain K. Antiphospholipid Syndrome Nephropathy and Other Thrombotic Microangiopathies Among Patients With Systemic Lupus Erythematosus. Adv Chronic Kidney Dis. 2019 Sep;26(5):376-386.

[2]Ermakova NA, Alekberova ZS, Reshetniak TM, Kalashnikova LA, Kosheleva NM. [Retinal vascular lesions in systemic lupus erythematosus and secondary antiphospholipid syndrome]. Vestn Oftalmol. 2005 Sep-Oct;121(5):31-6.

[3]Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006 Feb;4(2):295-306.

Figure 1. A) Forest plot of univariate analysis; B) Forest plot of multivariate logistic regression; C) Cluster analysis of variables.

Disclosure of Interests:

None declared

POS0186 METABOLOMIC SIGNATURES FOR KNEE CARTILAGE VOLUME LOSS OVER 10 YEARS

Background:

Osteoarthritis (OA) is the most common form of arthritis, and its impact is increasing year by year due to an aging population and lack of effective treatments. One of the main structural pathological changes of OA is the loss of articular cartilage. Tools that can predict cartilage loss would help identify people at high risk, thus preventing OA development.

Objectives:

Using a metabolomics approach, the current study aimed to identify serum metabolomic signatures for predicting the loss of knee cartilage volume over 10 years in a well-established community-based cohort - the Tasmania Older Adult Cohort (TASOAC).

Methods:

TASOAC is an on-going, prospective, population-based study of older adults who were randomly selected from the roll of electors in Southern Tasmania, Australia. Participants had a right knee magnetic resonance imaging (MRI) scan at baseline and a 10-year follow-up. Cartilage volume was measured in the medial, lateral, and patellar compartments and change in cartilage volume over 10 years was calculated as percentage change per year. Fasting serum samples collected at 2.6-year follow-up were metabolomically profiled using the TMIC Prime Metabolomics Profiling Assay which measures a total of 143 metabolites. 129 metabolite concentrations passed the quality control and the pairwise ratios of them as the proxies of enzymatic reaction were calculated. Linear regression models were used to test the association between each of the metabolite ratios and change in cartilage volume in each of the knee compartments with adjustment for age, sex, and body mass index (BMI). The significance was defined at a=3.0×10-6 to control multiple testing of 16,512 ratios with Bonferroni method.

Results:

A total of 344 participants (51% females) were included. The mean baseline age was 62.83±6.13 years and the mean BMI was 27.48±4.41 kg/m2. The average follow-up time was 10.84±0.66 years. Cartilage volume reduced by 1.34±0.72%, 1.06±0.58%, and 0.98±0.46% per year in the medial, lateral, and patellar compartments, respectively. Our data showed that an increased ratio of hexadecenoylcarnitine (C16:1) to tetradecanoylcarnitine (C14) was associated with a 0.12±0.02% per year reduction in patellar cartilage volume (p = 8.80×10-7). An increased ratio of hexadecenoylcarnitine (C16:1) to dodecanoylcarnitine (C12) was also associated with a 0.12±0.02% per year reduction in patellar cartilage volume (p = 2.66×10-6). While there were several metabolite ratios associated with cartilage volume loss in the medial and lateral compartments, none of them reached the predefined significance level.

Conclusion:

Our data suggested that alteration of fatty acid β-oxidation is involved in knee cartilage loss, especially in the patellar compartment, and the serum ratio of C16:1 to C14 and to C12 could be used to predict long-term patellar cartilage loss.

Acknowledgements:

We thank all the study participants who made the study possible. The original TASOAC study was supported by the National Health and Medical Research Council (NHMRC) and the current study was supported by the Canadian Institutes of Health Research (CIHR).

Disclosure of Interests:

None declared

Setting the new FRAX reference threshold without bone mineral density in Chinese postmenopausal women

PURPOSE

Despite the large number of osteoporosis patients in China, the diagnosis and treatment rates remain low. The Fracture Risk Assessment Tool (FRAX) can be used to effectively evaluate fracture risk. In this study, we explored the Chinese-specific thresholds of FRAX without the T-score.

METHODS

In all, 264 postmenopausal women aged > 50 years were randomly recruited from community-medical centers. All subjects completed self-reported questionnaires, BMD measurements, and spinal radiographs. The 10-year hip and major osteoporotic fracture risks were calculated by FRAX. A new threshold for both 10-year hip and major osteoporotic fracture risk was explored with receiver operating characteristic (ROC) curve analysis.

RESULTS

Overall, 92 subjects were diagnosed with osteoporosis. Among them, 14 participants with T-score > - 2.5 were diagnosed with osteoporosis based on clinical fractures. ROC analysis showed the cut-off value of the 10-year hip osteoporotic fracture for detecting osteoporosis was 0.95%, while that of 10-year major osteoporotic fracture was 4.95%. The sensitivity and specificity of the 10-year hip osteoporotic fracture probability for detecting osteoporosis were 0.86 and 0.59, respectively, while the guideline-recommended threshold had a sensitivity of 0.49 and specificity of 0.83. The sensitivity and specificity of the 10-year major osteoporotic fractures with the new threshold were 0.76 and 0.69, respectively, while the recommended threshold had a sensitivity of 0 and specificity of 1.

CONCLUSION

Current guideline-recommended FRAX thresholds without BMD showed low sensitivity. Therefore, 10-year osteoporotic hip fracture probability ≥ 0.95% and 10-year osteoporotic major fracture probability ≥ 4.95% are recommended as the new thresholds.

Krüppel-like factor 6 promotes odontoblastic differentiation through regulating the expression of dentine sialophosphoprotein and dentine matrix protein 1 genes

AIM

To investigate the potential role of Krüppel-like factor 6 (KLF6) in the odontoblastic differentiation of immortalized dental papilla mesenchymal cells (iMDP-3) cells.

METHODOLOGY

Alizarin Red S (ARS) and Alkaline phosphatase (ALP) staining was used to examine the mineralization effect of iMDP-3 cells after odontoblastic induction. Real-time PCR and Western blotting were employed to analyse dentine sialophosphoprotein (DSPP), dentine matrix protein 1 (DMP1), RUNX family transcription factor 2 (RUNX2), ALP and KLF6 expression during this process. Co-expression of the KLF6 with DMP1, DSPP and RUNX2 was detected by double immunofluorescence staining to explore their local relationship in the cell. To further investigate KLF6 functions, Klf6 gain- and loss-of-function assays followed by ARS and ALP stainings, real-time PCR and Western blotting were performed using Klf6-overexpression plasmids and Klf6 siRNA to investigate whether changes in Klf6 expression affect the odontoblastic differentiation of iMDP-3 cells. Dual-luciferase reporter assays were used to elucidate the mechanistic regulation of Dspp and Dmp1 expression by Klf6. Means were compared using the unpaired t-test and Kruskal-Wallis one-way anova with P < 0.05 and P < 0.01 defined as statistical significance levels.

RESULTS

The expression levels of Klf6 (P < 0.01), Dspp (P < 0.05), Dmp1 (P < 0.01), Runx2 (P < 0.01) and Alp (P < 0.01) were significantly elevated during odontoblastic differentiation of iMDP-3 cells. KLF6 was co-localized with DSPP, DMP1 and RUNX2 in the cytoplasm and nucleus of iMDP-3 cells. Overexpression of Klf6 promoted the odontoblastic differentiation of iMDP-3, whereas the inhibition of Klf6 prevented this procession. Dual-luciferase assays revealed that Klf6 upregulates Dspp and Dmp1 transcription in iMDP-3 cells during odontoblastic differentiation.

CONCLUSION

Klf6 promoted odontoblastic differentiation by targeting the transcription promoter of Dmp1 and Dspp. This study may offer novel insights into strategies for treating injuries to dental pulp tissue.

Cellular viability and death biomarkers enables the evaluation of ocular irritation using the bovine corneal opacity and permeability assay

The BCOP assay is used in the identification of chemicals that cause no ocular irritation or serious damage. However, this method has not been found to adequately discriminate between mild from moderate ocular irritation (category 2A/2B), based upon the animal data. In this study, we aimed to establish methods for discerning ocular irritation by chemicals. We used the BCOP assay and the fluorescence staining methods based on biomarkers for cellular viability and death. The potential for ocular irritation by 12 chemicals from different UN GHS categories was assessed by the BCOP assay. Cryosections of bovine corneas were obtained. The necrotic nucleus was TUNEL labeled, cytoplasmic f-actin was stained by phalloidin while the nucleus was stained by DAPI. The depth of injury (DOI) was then measured. According to BCOP assay, in vivo data of Draize eye test and DOI, the results showed that category NC irritants caused ≤ 10 % epithelial DOI, irritants of category 2B caused >10 % epithelial DOI and showed no stromal damage, while category 2A showed damage to the stroma. Based on these results, the GHS prediction model could distinguish between GHS 2A and 2B. Authenticating the viability of BCOP by DOI measurements can provide a more reliable basis for classifying ocular irritants.

LncRNA UCA1 affects osteoblast proliferation and differentiation by regulating BMP-2 expression

OBJECTIVE

The aim of this study was to detect the expression of long non-coding ribonucleic acid (lncRNA) urothelial carcinoma associated 1 (UCA1) in the plasma of patients with osteoporosis (OST), and to investigate its influences on the proliferation and differentiation of osteoblasts and its mechanism.

PATIENTS AND METHODS

Plasma samples were collected from 52 OST patients treated in our hospital and 30 healthy subjects receiving a physical examination, respectively. The expression level of lncRNA UCA1 in OST patients and healthy subjects were detected via Reverse Transcription-Polymerase Chain Reaction (RT-PCR). Furthermore, osteoblast MC3T3-E1 cell lines with a stable knockout of UCA1 in mice were constructed using small-interfering RNA (siRNA). The influence of UCA1 knockout on the proliferation of osteoblasts was detected using cell counting kit-8 (CCK-8) assay. Meanwhile, the proportion of EdU-positive cells in osteoblasts of the control group and UCA1 knockout group was detected using EdU staining. Moreover, the messenger RNA (mRNA) levels of differentiation-related genes, including Runt-related transcription factor 2 (Runx2), Collagen1α1, osteoclast (OC), osteoprotegerin (OPG), osteopontin (OPN) and Osterix (OSX), were detected via RT-PCR. The protein expression level of Runx2 was detected via Western blotting. In addition, osteoblasts were cultured with a bone-derived medium for 14 d. Then, the differentiation status was detected via alizarin red staining and alkaline phosphatase staining. Finally, the expression of bone morphogenetic protein-2 (BMP-2)/(Smad1/5/8) signaling pathway was analyzed using Western blotting.

RESULTS

The expression of plasma lncRNA UCA1 was significantly increased in OST patients (p<0.05). Cell experiments revealed that UCA1 siRNA intervention could significantly promote the proliferation and differentiation of osteoblast MC3T3-E1 cell lines. In addition, Western blotting showed that the pro-apoptotic effect of UCA1 might be mediated by the BMP-2/(Smad1/5/8) signaling pathway in osteoblasts.

CONCLUSIONS

Inhibiting lncRNA UCA1 can promote the proliferation and differentiation of osteoblasts by activating the BMP-2/(Smad1/5/8) signaling pathway in osteoblasts. Therefore, UCA1 is expected to be a new therapeutic target for OST.

A soft manipulator for efficient delicate grasping in shallow water: Modeling, control, and real-world experiments

Collecting in shallow water (water depth: ~30 m) is an emerging field that requires robotics for replacing human divers. Soft robots have several promising features (e.g., safe interaction with the environments, lightweight, etc.) for performing such tasks. In this article, we developed an underwater robotic system with a three-degree-of-freedom (3-DoF) soft manipulator for spatial delicate grasping in shallow water. First, we present the design and fabrication of the soft manipulator with an opposite-bending-and-stretching structure (OBSS). Then, we proposed a simple and efficient kinematics method for controlling the spatial location and trajectory of the soft manipulator’s end effector. The inverse kinematics of the OBSS manipulator can be solved efficiently (computation time: 8.2 ms). According to this inverse kinematics method, we demonstrated that the OBSS soft manipulator could track complex two-dimensional and three-dimensional trajectories, including star, helix, etc. Further, we performed real-time closed-loop pick-and-place experiments of the manipulator with binocular and on-hand cameras in a lab aquarium. Hydrodynamic experiments showed that the OBSS soft manipulator produced little force (less than 0.459 N) and torque (less than 0.228 N·m), which suggested its low-inertia feature during the underwater operation. Finally, we demonstrated that the underwater robotic system with the OBSS soft manipulator successfully collected seafood animals at the bottom of the natural oceanic environment. The robot successfully collected eight sea echini and one sea cucumber within 20 minutes at a water depth of around 10 m.

Mitochondrial ribosomal protein S9M is involved in male gametogenesis and seed development in Arabidopsis

Mitochondrial function is critical for cell vitality in all eukaryotes including plants. Although plant mitochondria contain many proteins, few have been studied in the context of plant development and physiology. We used knock-down mutant RPS9M to study its important role in male gametogenesis and seed development in Arabidopsis thaliana. Knock-down of RPS9M in the rps9m-3 mutant led to abnormal pollen development and impaired pollen tube growth. In addition, both embryo and endosperm development were affected. Phenotype analysis revealed that the rps9m-3 mutant contained a lower amount of endosperm and nuclear proteins, and both embryo cell division and embryo pattern were affected, resulting in an abnormal and defective embryo. Lowering the level of RPS9M in rps9m-3 affects mitochondrial ribosome biogenesis, energy metabolism and production of ROS. Our data revealed that RPS9M plays important roles in normal gametophyte development and seed formation, possibly by sustaining mitochondrial function.

[COVID-19 pandemic: global epidemiological trends and China's subsequent preparedness and responses]

The outbreak of COVID-19 has spread quickly across 114 countries/territories/areas in six continents worldwide and has been announced as a pandemic by WHO. This study analyzed global COVID-19 epidemiological trends, examined impact of the pandemic on global health security, diplomacy, and social environment in China, and provided short- and long-term strategic policy recommendations for China's subsequent preparedness and responses.

[Main non-state actors and progress of actions in global malaria elimination programme: a review]

With the joint efforts of countries and global non-state actors, great achievements have been made in the global malaria control programme; however, malaria remains a serious threat to human health. As the global leader for combating malaria, WHO formulated The Global Technical Strategy for Malaria 2016-2030, and the Global Malaria Programme, under the leadership of WHO, is responsible for implementing 5 key projects to achieve the goal proposed in The Global Technical Strategy for Malaria 2016-2030. In addition, the Global Fund, the U.S. President's Malaria Initiative and Bill & Melinda Gates Foundation also play an important role in global malaria elimination programme. This review describes the currently main non-state actors participating in the global malaria elimination programme, and calls for the enhanced inter-actor coordination and close collaboration with state governments to achieve the great goal of malaria elimination in the world.

CT characteristics of patients infected with 2019 novel coronavirus: association with clinical type

AIM

To summarise the features of chest computed tomography (CT) of a series of patients infected with 2019 novel coronavirus (2019-nCov) to speed up recognition and have a better understanding of COVID-19 disease.

MATERIALS AND METHODS

The clinical information and chest CT images of 93 patients infected with 2019-nCov from multiple centres were reviewed.

RESULTS

Of the 93 cases, abnormalities in 91 cases were located at the subpleural level, presenting with ground-glass opacity (GGO; n=69, 74.2%) and consolidation (n=56, 60.2%) in multiple lobes. Other CT features included vascular dilatation (n=83, 89.2%), interlobular septal thickening (n=29, 31.2%), bronchodilatation (n=44, 47.3%), the crazy-paving sign (n=34, 36.6%), the sieve-hole sign (n=12, 12.9%), pleural thickening (n=21, 22.6%), and pleural effusion (n=8, 8.6%). Multiple lobe involvement, including the presence of consolidation, the crazy-paving sign, interlobular septal thickening, pleural thickening and pleural effusion, was more common in critical patients with heavy/critical infection (p<0.05), whereas the presence of GGO, involvement of one or two lobes, and the halo sign were more common in patients with mild/common-type infections (p<0.05). Moreover, older age, higher body temperature, complaints of chest tightness and breathlessness, and lymphopenia was associated with heavy/critical infections.

CONCLUSION

The CT and clinical appearances of COVID-19 are variable and reflect the severity of COVID-19 to some extent.

Single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) of hernia sac high ligation using an ordinary taper needle: a novel technique for pediatric inguinal hernia

PURPOSE

Laparoscopic high ligation of the internal inguinal ring is an alternative procedure for treatment of pediatric inguinal hernia (PIH), with a major trend toward increasing use of extracorporeal knotting and decreasing use of working ports. We have utilized this laparoscopic technique to treat the entire spectrum of PIH (including incarcerated cases) for more than 17 years, and the technique continues to evolve and improve. We herein report our latest modification of this minimally invasive technique, namely single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) of hernia sac high ligation using an ordinary taper needle, and evaluate its safety and efficacy.

METHODS

From July 2016 to July 2019, 790 children with indirect PIH were treated by laparoscopic surgery. All patients underwent high ligation surgery with a modified single-site laparoscopic technique mainly performed by extracorporeal suturing with an ordinary closed-eye taper needle (1/2 arc 11 × 34). The clinical data were retrospectively analyzed.

RESULTS

All surgeries were successful without serious complications. A contralateral patent processus vaginalis (CPPV) was found intraoperatively and subsequently repaired in 190 patients (25.4%). The mean operative time was 15 min (8-25 min) for 557 unilateral hernias and 21 min (14-36 min) for 233 bilateral hernias. The mean postoperative stay was 20 h. Minor complications occurred in five patients (0.63%) and were managed properly, with no major impact on the final outcomes. No recurrence was noted in the patients who were followed up for 6-42 months. No obvious scar was present postoperatively.

CONCLUSION

Modified SLPEC of hernia sac high ligation using an ordinary taper needle for repair of indirect PIH is a safe, reliable, and minimally invasive procedure with satisfactory outcome, with no special device being needed. It is easy to learn and perform and is worthy of popularization in the clinical setting.

Octopus Arm-Inspired Tapered Soft Actuators with Suckers for Improved Grasping

Octopuses can employ their tapered arms to catch prey of all shapes and sizes due to their dexterity, flexibility, and gripping power. Intrigued by variability in arm taper angle between different octopus species, we explored the utility of designing soft actuators exhibiting a distinctive conical geometry, compared with more traditional cylindrical forms. We find that these octopus-inspired conical-shaped actuators exhibit a wide range of bending curvatures that can be tuned by simply altering their taper angle and they also demonstrate greater flexibility compared with their cylindrical counterparts. The taper angle and bending curvature are inversely related, whereas taper angle and applied bending force are directly related. To further expand the functionality of our soft actuators, we incorporated vacuum-actuated suckers into the actuators for the production of a fully integrated octopus arm-inspired gripper. Notably, our results reveal that because of their enhanced flexibility, these tapered actuators with suckers have better gripping power than their cylindrical-shaped counterparts and require significantly larger forces to be detached from both flat and curved surfaces. Finally, we show that by choosing appropriate taper angles, our tapered actuators with suckers can grip, move, and place a remarkably wide range of objects with flat, nonplanar, smooth, or rough surfaces, as well as retrieve objects through narrow openings. The results from this study not only provide new design insights into the creation of next-generation soft actuators for gripping a wide range of morphologically diverse objects but also contribute to our understanding of the functional significance of arm taper angle variability across octopus species.

Complex multiphase organohydrogels with programmable mechanics toward adaptive soft-matter machines

Many biological organisms can tune their mechanical properties to adapt to environments in multistable modes, but the current synthetic materials, with bistable states, have a limited ability to alter mechanical stiffness. Here, we constructed programmable organohydrogels with multistable mechanical states by an on-demand modular assembly of noneutectic phase transition components inside microrganogel inclusions. The resultant multiphase organohydrogel exhibits precisely controllable thermo-induced stepwise switching (i.e., triple, quadruple, and quintuple switching) mechanics and a self-healing property. The organohydrogel was introduced into the design of soft-matter machines, yielding a soft gripper with adaptive grasping through stiffness matching with various objects under pneumatic-thermal hybrid actuation. Meanwhile, a programmable adhesion of octopus-inspired robotic tentacles on a wide range of surface morphologies was realized. These results demonstrated the applicability of these organohydrogels in lifelike soft robotics in unconstructed and human body environments.